Finishing the Bridge to Diversity - Member Profile - AAMC

Finishing the Bridge
to Diversity

1
5
6
10
2 4
3
9
7
8
11
13
12
1. Regina M. Benjamin, M.D., M.B.A., solo practitioner
in Bayou La Batre, Alabama; member American
Medical Association Board of Trustees
2. Griffin P. Rodgers, M.D., Chief, Molecular Hematology,
National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health
3. Patrice Desvigne-Nickens, M.D., Director, Heart
Research Program, National Institutes of Health
4. Mark D. Smith, M.D., M.B.A., President and Chief
Executive Officer, California HealthCare Foundation
5. Samuel M. Aguayo, M.D., F.A.C.P., F.C.C.P., Associate
Chief of Staff/Education, Atlanta Veterans Affairs
Medical Center, and Associate Professor of Medicine,
Emory University School of Medicine
6. Melvina McCabe, M.D., Associate Professor, Department
of Family and Community Medicine, University of
New Mexico School of Medicine
7. Reed V. Tuckson, M.D., President, Charles R. Drew
University of Medicine and Science
8. Herbert W. Nickens, M.D., Vice President of
Community and Minority Programs
9. Mae C. Jemison, M.D., President, the Jemison Group;
former NASA astronaut
10. Benjamin S. Carson, M.D., Director, Pediatric
Neurosurgery, Johns Hopkins Medical Institutions
11. Helene D. Gayle, M.D., M.P.H., Director, National
Center for HIV, STD, and TB Prevention, Centers
for Disease Control and Prevention (CDC)
12, Woodrow A. Myers, Jr., M.D., M.B.A., Director, Health
Care Management, Ford Motor Company
13. Walter B. Hollow, M.D., Director, Native American
Center of Excellence, University of Washington
School of Medicine
This is a slightly edited version of the President’s Address presented November 8,
1996 at the Plenary Session of the 107th Annual Meeting of the Association of
American Medical Colleges (AAMC), held in San Francisco, November 6-12, 1996.
Dr. Cohen is president of the AAMC, Washington, D.C.
Correspondence and requests for reprints should be addressed to the Office of
the President at the AAMC, 2450 N Streeet, NW, Washington, DC 20037-1127.

1965 Residency Class, Harvard University School of Medicine

Finishing the Bridge to Diversity
Finishing the Bridge to Diversity
Jordan J. Cohen, M.D.
I want to call you all to action.
To take firm leadership on this
issue. Leadership in educating
the best doctors. Leadership in
providing quality health care.
And leadership in finding answers
to major health problems.
FFor my part today, I have chosen to discuss a more longstanding challenge.
One that has been with us much longer than either managed care or Web
pages. I want to talk about finishing the bridge to diversity. This bridge-building
challenge differs a lot, I think, from others that are commanding so much of
our attention. For one thing, although the tools we need for this work stem,
as always, from carefully honed analyses of the data, those tools must be
sharpened for this particular task by something in addition to data — by
deeply felt passion.
My plan is to set forth the reasons why I think achieving diversity in
medicine is so critical. I want to call your attention to some historical arguments,
some practical arguments, and some moral arguments. In the end, I
want to call you all to action. To take firm leadership on this issue. Leadership
in educating the best doctors. Leadership in providing quality health care.
And leadership in finding answers to major health problems. None of these
goals can be achieved, in my judgment, without taking leadership to bridge
the appalling diversity gap that still separates medicine from the society it
professes to serve.
1

Finishing the Bridge to Diversity
The Challenge for Academic Medicine
To establish the context for my remarks, let me review some familiar
facts. The population of the United States continues to grow and will do so
well into the next century (Figure 1). The truly dramatic change to come,
however, is not the size
Millions
500
400
300
200
100
Growth of US Population
Today
0
1950 1970 1990 2010 2030 2050
YEAR
of our population but its
composition. Our population
is growing older,
as every one knows, and
it also is growing racially
and ethnically more
diverse (Figure 2).
Minority populations are
increasing much more
rapidly in this country
than is the majority white
population. As shown in
Figure 2, between 1980
and 1995, while our
country’s white population
Figure 1. Growth and projected growth
of the U.S. population, 1950-2050.
grew by about
12%, our black
population
increased twice
as fast, by
about 24%;
our Native
American population
grew
by 57%; our
Hispanic population,
by 83%;
and our Asian
population, by
more than
Percent
200
150
100
50
0
Recent Growth in Subgroups
of US Population
12%
24%
57%
83%
160%
White Black Native Hispanic Asian
American
Figure 2. Increases, in percentages, of subgroups of the U.S. population, 1980-1995.
2

Finishing the Bridge to Diversity
160%. The result, as
shown in Figure 3, is
that somewhere in the
middle of the next century,
the majority of our
citizens will be members
of minority groups.
So what What do
these striking demographic
trends describing the
future complexion of
America have to do with
our responsibilities as
stewards of medicine’s
future I find the answer
to that question pretty
straightforward. Academic
medicine is, after all, largely
about the future. It’s about
Percent
100
80
60
40
20
The Future Complexion
of America
0
1980 1990 2000 2010 2020 2030 2040 2050
YEAR
improving the health of future generations by educating the physicians who
will care for tomorrow’s children, and by discovering better ways to keep
tomorrow’s children healthy. Given that our primary obligation to society is to
furnish it with a physician workforce appropriate to its needs, our mandate is
to select and prepare students for the profession who, in the aggregate, bear a
reasonable resemblance to the racial, ethnic, and of course, gender profiles of
the people they
will serve. In
Academic medicine is, after all, largely about the future. It’s about
other words, a
improving the health of future generations by educating the physicians
medical profession
that looks
who will care for tomorrow’s children, and by discovering better ways
like America. We to keep tomorrow’s children healthy.
have made substantial
progress on this front with respect to gender; but, as these data suggest,
we’ve still got a long, long way to go with respect to race and ethnicity.
But why should anyone care if the medical profession reflects society’s
racial and ethnic makeup as long as we have plenty of well-trained practitioners
of whatever background The reasons are many. Let me mention five that
stand out in my mind:
Asian
Hispanic
Native
American
Black
White
Figure 3. Changes and projected changes in the relative sizes of five racial-ethnic groups in the
U.S. population, 1980-2050.
3

Finishing the Bridge to Diversity
Achieving Justice and Equity
First is the simple matter of justice and equity. The medical profession,
and the health professions in general, occupy a lofty status in American society,
and offer those who pursue them many of the most challenging and rewarding
career opportunities available anywhere. As physicians, for us to seek justice
within our own profession is, I believe, only to be faithful to our cardinal
commitment to respect everyone’s individuality equally.
Ensuring Access to Health Care
The second reason is a matter of improved access to health care for the
underserved. Abundant data now exist to document unequivocally that black,
Hispanic, and native American physicians are much more likely than whites and
Asians to practice in underserved communities. Not that minority physicians
are, or should be, under any obligation to do so; not that minority physicians
are not, and should not be, free to settle and practice wherever and however
they choose; and not that other physicians do not contribute importantly to
improving access among the underserved. The simple fact is that minority
physicians do so with greater predictability. And getting the job done means
producing more minority physicians to lead the way.
Providing Culturally Competent Care
The third reason for increasing diversity among our students — and
faculty, I might add — has to do with learning how to deliver culturally competent
care. Given the
expanding
Learning how to deliver culturally competent care means learning
diversity
medicine with students and from faculty who are themselves emblematic
throughout our
of society’s diversity. Textbooks alone just won’t cut it.
society, all
physicians of
the future will need this essential skill, and must be given a strong foundation
in what it means to deliver culturally competent care.
If they are truly to care for their diverse patients, physicians of whatever
background must have a firm grasp on how various belief systems, cultural
biases, family structures, historical realities, and a host of other culturally
determined factors influence the way people experience illness and the way
they respond to advice and treatment. Such differences are real and translate
into real differences in the outcomes of care. But should you find this argument
unconvincing, let me remind you of a pragmatic consideration — of the
4

Finishing the Bridge to Diversity
increasing importance of customer satisfaction. As our patients become culturally
more diverse, our ability to meet their culturally determined expectations will
strongly influence their choice of caregivers. The connection between all of
this and the need to expand diversity in the educational environment is clear.
Learning how to deliver culturally competent care means learning medicine
with students and from faculty who are themselves emblematic of society’s
diversity. Textbooks alone just won’t cut it.
Setting an Appropriately Comprehensive Research Agenda
A fourth reason for addressing diversity has to do with our research
agenda. Our society as a whole is plagued by many unsolved health problems,
many of which swirl disproportionately around our minority populations. Our
country’s research agenda is set in large measure by those who have chosen
careers in investigation. Individual investigators, in turn, tend to do research
on problems that they “see” and have an interest in. And what people see, and
what tickles their fancy, depends to a great extent on their particular cultural
and ethnic filters. Recognizing all these truths leads to the reality that finding
solutions to our country’s most recalcitrant health problems, even being able
to conceptualize what the real problems actually are, will require a research
workforce that is much more diverse racially, ethnically, and by gender than
we now have. Creating that workforce begins with ensuring diversity among
those admitted to our M.D. and Ph.D. educational programs.
Securing the Talent Needed To Lead the Health Care Enterprise
into the Twenty-first Century
My fifth and final reason for the need to achieve diversity in the medical
profession relates to management of the health care system. Physicians must
continue to exert leadership — some would say re-exert leadership — in the
management of the health care enterprise, especially now that that enterprise
is becoming
increasingly We must draw the future physician leadership for our health care
corporatized. systems... from a richly diverse pool of talent, adequately reflecting
But assuming our country’s gender, racial, and ethnic mélange. It’s simply smart
management
business to do so.
responsibility
for a system destined to serve the health care needs of an increasingly diverse
people is a job that can only be done well by equally diverse management
teams. We must draw the future physician leadership for our health care sys-
5

Finishing the Bridge to Diversity
Percent
15
12
9
6
3
0
tems — as we must for all other
professional and non-professional
sectors of the American economy
— from a richly diverse pool of talent,
adequately reflecting our
country’s gender, racial, and ethnic
mélange. It’s simply smart business
to do so.
So, five reasons stand out for
seeking diversity in the medical
profession: achieving justice and
equity; ensuring access to health
care; providing culturally competent
care; setting an appropriately comprehensive research agenda; and
securing the talent needed to lead the health care enterprise into the twentyfirst
century.
Taking a Historical Look
How are we doing Let’s take a historical look. Until the mid 1960s or
so, the racial — and, of course, gender — composition of medical school classes,
and hence of the medical
Underrepresented Minorities
US Population vs Medical School Matriculants
% URMs in US Population
1966
1964
1962
1960
1958
1956
1954
1952
1950
% URM Matriculants
YEAR
Figure 4. The era before affirmative action: percentages of underrepresented minorities
(URMs) in the U.S. population and as matriculants in medical schools, 1950-1966.
Seeking Diversity in the Medical
Profession Will Help Achieve:
• Just and equitable access to rewarding careers
• Improved access to health care for the
underserved
• Culturally competent care
• A comprehensive research agenda
• Use of the rich and diverse pool of the nation’s
talent to better manage the health care system.
profession, was composed,
monotonously, of white men.
As shown in Figure 4, despite
a progressively expanding,
double-digit presence in our
population, groups that we
now designate as underrepresented
minorities made up
only about 2% of medical
school matriculants, and
three-quarters of those
attended either Howard or
Meharry. The typical medical
school of that era admitted
one minority student every
other year. I graduated from
medical school in 1960, one
of the off years. In my class of
6

Finishing the Bridge to Diversity
140, there were 134 white men and six white women. And that was a banner
year for women.
In my 1965 residency class, there were no women (except nurses), no blacks,
no Hispanics, no Native Americans, not even an Asian American. Racial segregation
was as fully evident in medicine as it was in virtually every sector of
American society,
just as it had In my 1965 residency class, there were no women, no blacks, no Hispanics,
been for many
no Native Americans, not even an Asian American. Racial segregation
preceding
was as fully evident in medicine as it was in virtually every sector of
decades. But
things began to
American society, just as it had been for many preceding decades.
change in the
late 1960s. The civil rights movement, the assassination of Martin Luther King,
and a rash of urban riots woke many people up. And academic medicine was
among the first to get the wake-up call. The result was a dramatic rise in the
admission of minorities to medical schools (Figure 5). Although not shown in
Figure 5, women also began to matriculate in record numbers. Was this because
scores on the Scholastic Aptitude Test, grade-point averages, and Medical College
Admission Test scores of women and minority students suddenly began to
skyrocket. Of course not. What changed — what led to the dramatic rise in
women and minority matriculants to medical school — was simply that academic
medicine began to take affirmative
actions to increase the
racial, ethnic, and gender
diversity of medical school
classes.
As shown in Figure 5,
enrollment of underrepresented
minorities in U.S.
medical schools rose rapidly
to about 8% of all matriculants
by the early 1970s. But,
as you can see, progress on
our bridge to diversity stalled
in the mid 1970s, with admissions
remaining virtually flat
for the next 15 years or so.
To make matters worse, the
fraction of individuals from
the same groups in the U.S.
population that were under-
Percent
20
15
10
5
0
1950
The ’60s Wake Up Call
% URM Matriculants
1955
1960
% URMs in US Population
1965
1970
YEAR
Figure 5. Early success of affirmative action: percentages of underrepresented minorities
(URMs) in the U.S. population and as matriculants in medical schools, 1950-1990, showing
a sharp increase in the late 1960s as a result of affirmative actions.
1975
1980
1985
1990
7

Finishing the Bridge to Diversity
represented in medicine continued to grow during this period, as shown in
the top line in Figure 5, increasing from 16% in 1975 to 19% in 1990. Our
bridge to diversity, in other words, was less than halfway across the chasm,
and the gap was widening under our eyes. Clearly it was time to call in the
engineers to reevaluate our bridge-building strategy. We did so, and the result
was Project 3000 by 2000.
Creating Partnerships
When Bob Petersdorf announced this important initiative at the 1991
meeting of this association just five years ago, he noted that the root cause of
minority underrepresentation in medical schools in the present era is the
accumulated academic disadvantages borne by too many minority young
people simply because they lack access to high-quality, precollege and college
educations. As a consequence, groups of applicants from the various and
diverse sectors of our population do not arrive at our admission offices with
equivalent academic credentials. Clearly, the only satisfactory fix for this dilemma
in the long run is fundamental reform of our country’s education system.
And that is the core mission of Project 3000 by 2000: to contribute what
we can — in concert with a host of other public and private initiatives — to
the long-term solution for a very complex, multifactorial, recalcitrant social
catastrophe. As you know, the Project’s core strategy is to effect small-scale
educational reform through
durable, minority-focused community
partnerships, partnerships
among academic medical centers
and those K-12 school systems and
colleges that are responsible for the
academic preparation of potential
underrepresented minority applicants.
This is the novel element of
the Project’s strategy: To create
honest-to-God partnerships with
selected feeder schools that will
complement and reinforce the many
useful approaches undertaken for
years by many in the academic
medicine community.
Special programs, including
magnet health science high schools,
articulation agreements, and science
Project 3000 by 2000
Mission Statement
To eliminate the underrepresentation of blacks,
Native Americans, Mexican Americans, and Mainland
Puerto Ricans in U.S. medical schools.
Core Strategy
To effect small-scale educational reform through durable,
minority-focused partnerships of academic medical
centers and those K-12 school systems and colleges
that are responsible for the academic preparation of
potential applicants from underrepresented minorities.
Examples of What Works
• Magnet health science high schools
• Articulation agreements with feeder colleges
• Science education partnerships
• Early identification and fostering of interest and
talent
• Relationships with mentors
8

Finishing the Bridge to Diversity
education partnerships have been created to identify promising students early
in the educational pipeline, to enrich the science and related offerings available
to students
from poorly This is the novel element of the Project’s strategy: To create honest-toequipped
schools,
God partnerships with selected feeder schools that will complement and
to establish mentoring
relation-
reinforce the many useful approaches undertaken for years by many
ships to keep the in the academic medicine community.
flames of inquiry
and aspiration burning intensely, and to provide adequate counseling to ensure
that all the milestones on the long road to medical school are understood and met.
What happened after the launch of Project 3000 by 2000 What happened
was a second dramatic upturn in the number of underrepresented minorities
admitted to medical school (Figure 6). Indeed, the number began to rise almost
immediately and tracked right along the trajectory toward the Project’s numerical
goal of 3,000 new entrants to medical school among underrepresented groups
by the turn of the century. In 1994, for the first time in history, more than
2,000 underrepresented minority students entered medical school, up from
fewer than 1,500 in 1990.
But how is this possible I just got through saying that Project 3000 by
2000 was aiming at the long haul. How did it achieve such early success I
think one reason, for sure, was the new attention focused by the Project on the
Percent
25
Project 3000 by 2000
20
15
10
% URMs in US Population
% URM Matriculant
1,470
Matriculants
2,014
Matriculants
12%
10%
5
0
1988 1990 1992 1994
YEAR
1970
1966
1962
1958
1954
1950
1994
1990
1986
1982
1978
1974
Figure 6. Temporary rise in the percentage of underrepresented minorities (URMs) who were matriculated in medical
schools from 1990-1994. This upswing was partly due to increased attention that the launching of Project 3000 by 2000
(shown by circle) focused on the lack of adequate racial and ethnic diversity among medical students.
9

Finishing the Bridge to Diversity
lack of adequate racial and ethnic diversity among medical students. As a result,
we saw a significant increase in the fraction of underrepresented minority
applicants who gained acceptance at virtually every school. As it happens, we
also got a boost from the rising tide of applicants during this same period; the
pool of minority applicants rose along with the pool of all applicants. Call it
the Hawthorne effect if you like, but, in fact, the measurable progress made
during this phase validated, once again, the power of affirmative action.
Standing the Test
The next critically important question to address, and one that the critics
of affirmative action raise repeatedly, is whether the use of affirmative action as
a tool, and the resulting increase in the number of minority medical students,
leads to unqualified individuals becoming doctors. To raise such a question is
to concede ignorance of the facts. First of all, no one in their right mind would
argue for admitting anyone to medical school who did not evidence the academic
skills and personal
No one in their right mind would argue for admitting anyone to
qualities necessary
for completing
medical school who did not evidence the academic skills and personal
the M.D. degree.
qualities necessary for completing the M.D. degree.
Such an admission
policy would not
only violate our oath to patients, it would be a disastrous disservice to individual
students. And the data clearly show that medical schools are keen to avoid this
pitfall.
The vast majority of medical students from underrepresented minority
groups, as is true of all students admitted to medical school, do successfully
complete the rigorous requirements for graduation. Medical school admission
committees cannot be commended enough for the care they take in selecting
our country’s future physicians. That only a handful of students from all backgrounds,
majority and minority alike, prove unable to withstand the rigors —
or to meet the financial costs — of a medical education and must abandon the
quest along the line, is ample testimony to the skill and wisdom of our admission
committees.
But let’s return to the data for some less happy news. What is now evident,
unfortunately, is that the initial upturn in the admission of underrepresented
minorities following the launch of Project 3000 by 2000 leveled off in 1995,
and, even more alarmingly, actually fell — by more than 100 individuals —
among this year’s matriculants (Figure 7). After the historic high of 1994,
something changed. Has Project 3000 by 2000 run out of steam Quite the
10

Finishing the Bridge to Diversity
Percent
25
Our Bridge to Diversity is Sagging
20
15
10
% URMs in US Population
% URM Matriculants
2,014 URM
Matriculants
1,906 URM
Matriculants
12%
10%
5
1972
1968
1964
1960
1956
1952
1996
1992
1988
1984
1980
1976
0
1990 1992 1994 1996
YEAR
Figure 7. The bridge to diversity is sagging. The initial upturn in the admission of underrpresented minorities (URMs) following
the launch of Project 3000 by 2000 leveled off in 1995 and then fell by more than 100 individuals in 1996. This downturn
was partly due to weakened, and sometimes blocked, affirmative actions.
contrary. We learn of more and more educational partnerships and effective
programs every year. As I’ve tried to emphasize, Project 3000 by 2000 is aimed
at the long haul. The returns it will have on the investments it makes in educational
partnerships will accumulate slowly over the next several years, even
decades. It will take at least that long to fix the pipeline, to release us from the
need for short-term remedies.
And it’s precisely those short-term remedies that may well be in jeopardy.
What may be running out of steam, in other words, is the oomph behind affirmative
action programs, programs designed to reach out not only to those
qualified young people from underrepresented minority groups who are
already in the applicant pool, but also to those who should be in the pool, and
to those who, through short-term academic enrichment efforts, could qualify
to enter the pool. The reason for being suspicious that weakened affirmative
action efforts may be the culprit here is all too obvious, given the way its use is
being attacked on so many fronts.
Chilling Conclusions
For us in higher education, the Hopwood case was one of the most chilling
pieces of evidence that affirmative action is under attack. As you know, the
decision of the U.S. Court of Appeals for the Fifth Circuit in that case, which
11

Finishing the Bridge to Diversity
was let stand by the Supreme Court, has taken away the right of faculties in
Texas, Mississippi, and Louisiana to use race and ethnicity at all as factors in
admission to any university program. And as of three days ago, with the passage
of Proposition 209,
our colleagues
For us in higher education, the Hopwood case was one of the most
here in California
chilling pieces of evidence that affirmative action is under attack.
are no longer
free to consider
race, ethnicity, or gender in admission decisions, in recruiting programs, or
even in planning and implementing minority-targeted outreach activities, such
as tutoring programs and educational enrichment courses. California, Texas,
Mississippi, and Louisiana: these four states alone contain fully 35% of the
minority populations that remain underrepresented among medical students,
and fully 75% of those from the Mexican-American community.
Keeping Diversity in Academic Medicine’s Future
Those who oppose affirmative action, and I know many of you do, argue
either that it’s no longer needed, or that it’s ineffective, or that it’s unfair. Looking
at this contentious issue from the vantage point of the medical profession, I
maintain that all three of those arguments are false.
Is affirmative action in medical school admission still needed
Absolutely. Until the academic credentials of all groups in the applicant pool
are indistinguishable, we simply cannot use the same criteria to evaluate all
applicants. Let me be absolutely clear. Given the disparity in available measures
of academic achievement among applicants grouped by race and ethnicity, there
is simply no way
We must continue, for as long as necessary, to reach out to those we can select an
whose race and ethnicity, not their economic status alone, have adequately
subjected them to inferior academic preparations, but who, by dint diverse class of
of character, intelligence, and drive, are fully prepared to succeed medical students
as physicians and medical scientists.
today without
taking race and
ethnicity explicitly or implicitly into account. Using surrogates for race and
ethnicity can certainly help, but that approach is not an adequate substitute, in
my mind, for being forthright about what is needed. We must continue, for as
long as necessary, to reach out to those whose race and ethnicity, not their
economic status alone, have subjected them to inferior academic preparations,
but who, by dint of character, intelligence, and drive, are fully prepared to
succeed as physicians and medical scientists.
12

Finishing the Bridge to Diversity
Is affirmative action ineffective Certainly not in medicine. Indeed,
nowhere is the effectiveness of affirmative action more in evidence than in our
profession. Effective not only in narrowing our diversity gap, but effective in
greatly expanding access to care.
Is affirmative action unfair How in the world can it be unfair to boost
the chances of becoming a physician — to give special treatment to persons
who have been subjected to obscenely unfair discrimination because of their
heritage, and whose status in our democratic society remains tarnished
through no fault of their own. Okay, but how about being fair to all the other
applicants who don’t get the benefits of affirmative action. Look, we have many
more qualified applicants to medical school than we have places for them.
Most applicants come away empty-handed, and do so for a whole variety of
reasons. To single
out affirmative
If one of my kids or grandkids was rejected from medical school, I’d be
action for their
damned disappointed; but if they tried to blame it on reverse discrimination,
I’d say: Get a life.
disappointment
and plead unfair
treatment just
doesn’t compute. If one of my kids or grandkids was rejected from medical
school, I’d be damned disappointed; but if they tried to blame it on reverse
discrimination, I’d say: Get a life. Because I believe it’s time already to share
the wealth, to recognize that our profession needs — and our country needs
— the best talent it can find from every group in our society.
The Call to Action
As much as we’d like to think otherwise, and as much as we long for the
day when it’s no longer true, race and ethnicity still matter in America. To ignore
that reality in deciding who deserves to be admitted to medical school is to
ignore our duty as stewards of our profession’s future. I can tell you that the
AAMC does not intend to ignore its duty in this arena. As you may know, late
last spring we spearheaded the formation of a new coalition, Health
Professionals for Diversity. Over 30 of the nation’s leading medical, health, and
education organizations have signed-on to this coalition, and we all have pledged
to do whatever we can (1) to make the case for diversity in the healing professions,
(2) to prevent the spread of anti-affirmative action initiatives, and (3) to
release the constraints that have already been imposed on many of our faculties.
We must continue to produce physicians and scientists from all segments
of America. We must remember how many young minority physicians, with
their many talents and abundant energy, would have been lost to us if the
13

Finishing the Bridge to Diversity
enrollment practices from my era in medical school had not been reversed by
affirmative action. But simply repeating the rhetoric of the 1960s will not be
enough. We must face up to the fact that our society is being hammered at
present by a mean-spirited backlash. Race has once again become a political
“wedge” issue. A growing fraction of our citizens seems prepared to accept the
views expressed by some politicians that we can abandon affirmative action
efforts, that we have come far enough in undoing the ravages our society
suffered during
We must face up to the fact that our society is being hammered at present centuries of ugly
by a mean-spirited backlash. Race has once again become a political subjugation by
“wedge” issue.
race, that our
awful legacy of
racial and ethnic discrimination is behind us. We have a judge in the Hopwood
case, for example, who offers the opinion that race contributes no more to a
person’s identity than does his or her blood type. One wonders what planet
that judge is living on!
All of us must speak out to the opinion leaders and lawmakers in our
communities. This is a moral issue, and it is a health issue. Hence, it is our issue.
And the data are compelling. The consequence of abandoning affirmative
action programs prematurely will be a reduction in the availability, and a
deterioration in the quality, of health care services for everyone.
In jurisdictions like the Fifth Circuit and in California, where prohibitions
have been imposed on the use of race-conscious, affirmative-action tools, we
must work within the law to minimize the impact on minority enrollments. The
AAMC will seek to develop and disseminate to those states whatever lawful alternatives
we can find to ensure that qualified applicants from underrepresented
minority groups continue to be identified and recruited to medical schools.
We must redouble our efforts on behalf of Project 3000 by 2000. We must
work to accelerate the establishment of meaningful educational partnerships
with pipeline schools and encourage others to join in the effort. Each of us, as
citizens, needs to
In short, medicine must stay the course, we must not be afraid to lead. see our beleaguered
pubic
schools as the crucibles from which our future physicians will come, and use our
privileged place in American society to be advocates and champions of education.
In short, medicine must stay the course. We must not be afraid to lead.
We must finish the bridge to diversity we began to build in the 1960s. We
cannot allow thoughtless attacks on affirmative action to dismantle the fledgling
structure we have yet to complete, a structure without which at least some of
our minority colleagues would never have attained their dreams, never have healed
a patient, never have discovered new knowledge, never have led an institution,
never have inspired a student, and never have graced our profession.
14